When Alexander Flemming accepted his Nobel Prize for the discovery of penicillin, he issued a warning to future generations: his miracle drug—responsible for saving millions of lives—could one day be useless.
“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them,” Flemming said. “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
Seventy years later, Flemming’s nightmare scenario is coming true.
The U.S. Centers for Disease Control and Prevention (CDC) reports drug-resistant bacteria infect more than 2 million people nationwide, killing 23,000 annually. In addition to lives lost, infections cost $20 billion in additional direct healthcare costs, up to $35 billion in lost worker productivity, and $8 billion in extra hospital days. Given the knowledge and resources available to us, this is unacceptable.
We need a multi-pronged strategy to attack antibiotic resistance. The most needed interventions are not as expensive or complicated as developing new drugs. And the cost is a fraction of the financial impact these infections have today. The CDC’s new fiscal 2016 Antibiotic Resistance Solutions Initiative is a $264 million initiative to fully implement CDC’s activities under the National Strategy for Combating Antibiotic-Resistant Bacteria. Considering what is to come if we do not address this problem now, fully funding this initiative in the FY2016 budget should be an easy decision for policymakers.
We cannot ignore this problem. Bacteria are living organisms that will continue to evolve through genetic mutation to escape a predator – in this case the antibiotic. Their ability to develop resistance has been enhanced by antibiotic overuse or misuse. The results are highly virulent strains of bacteria we have increasingly seen developing in our communities and hospitals. Without intervention, we will see once-common and easily managed infections become lethal.
The CDC’s strategy is reasonable, well-conceived, and comprehensive starting with cost-effective high impact interventions in every state that will equip healthcare providers with the tools and expertise to combat antibiotic resistance.
The most immediate changes are in detection, prevention, and treatment. CDC Director Dr. Tom Frieden reports up to half of all antibiotics prescribed today are used improperly. They are prescribed inappropriately for viral infections or because a broad-spectrum antibiotic—meaning one that targets many different organisms—is inappropriately used for an infection when a more specific choice is available.
Changing this in practice is twofold. First, the initiative would fund widespread provider education to encourage better antibiotic stewardship. Second, it would support both better tracking and prevention of infections to identify resistance patterns in individual communities and the development of rapid diagnostic tests to help dispel the ambiguity that so frequently leads to using broad-spectrum drugs.
The National Strategy is also forward-looking by calling for the development of new antibiotics and vaccines. Because of the exorbitant costs—about $1 billion over a decade—to develop new antibiotics, many companies have dropped antimicrobial research in favor of more lucrative drugs. In fact, Pfizer closed its antibiotic research facility in Connecticut in 2011, and Eli Lilly and Bristol-Myers Squibb haven’t developed antibiotics in years.
I am happy to report that Congress is taking this issue seriously. In 2012, Congress passed the Generating Antibiotic Incentives Now (GAIN) Act to generate antibiotic research and development in part by extending patent exclusivity and providing a fast-track approval pathway. This year, Congressional leaders have signaled an interest in reforming the FDA, which could potentially streamline the clinical trials process, one of the biggest drivers of cost and time. The CDC initiative would support these efforts by significantly enhancing local and national surveillance of antibiotic resistance so that we can better target antibiotic development.
The CDC initiative also supports collaboration for containment and antibiotic stewardship worldwide, where the disease burden is far greater than in the United States. In India 58,000 babies die each year from super-resistant bacterial infections passed on from mothers—over twice the number of total deaths from resistance in the U.S. As we have seen from the Ebola epidemic, infectious diseases respect no borders. A failure to contain and treat infections in one part of the world quickly becomes a problem globally. Sharing knowledge of bacterial identification and antibiotic stewardship is imperative to curbing the development of superbugs everywhere.
For all of this work, the CDC’s proposal comes at a bargain price. $264 million is 0.4 percent of the $63 billion antibiotic resistant infections cost every year in the United States.
Superbugs will continue to emerge. It is simple biology. An infection we can treat today for $4 could cost $10,000 tomorrow because of antibiotic resistance. This problem is not going to go away without action.
As we look toward the future of medicine in our country—the move to value-based care and choosing high impact low cost interventions.
Frist, a physician, served as a senator from 1995 to 2007 and as majority leader from 2003 to 2007.